Like other developed Western nations, the elderly in Australia are confronted with numerous challenges to living independently as they grow older, including coping with age-related diseases processes such as dementia and obstructive airways disease as well as adjusting to the loss of a spouse. This case report provides a discussion concerning the application of the overarching and practice functions of the case management model described within the organisational and community contexts. A reflective discussion concerning the proposed approach to practice that focuses on decisions and reasons for practice, the effectiveness of the proposed practice and alternative approaches, skills or techniques that may be required to provide appropriate levels of care for Mr. William Doe who is described further below.

Review and Discussion

Overview of Client: "Mr. William Doe"

Mr. William Doe (hereinafter "Mr. Doe") is an 80-year-old Greek-Australian widower who has lived in Australia for the past 40 years. Like many other elderly individuals, Mr. Doe is experiencing the deleterious effects of aging, which have introduced some new problems while exacerbating existing ones. As Kirchengast and Haslinger (2009), this process is natural and should be expected in elderly individuals. For instance, according to Kirchengast and Haslinger (2009) point out, "Inevitably, increasing age is associated with increased exposure to risk factors and reduced adaptability, which results in disease, vulnerability and reduced quality of life" (p. 3).

At present, Mr. Doe appears slightly depressed, and this issue may have been overlooked by his health care practitioners to date. Nevertheless, this is an important issue since, "Depression, even the mild form, impacts many on the life of elderly in many ways. Depressed mood might lead to feelings of hopelessness and helplessness and a reduced meaningfulness of life" (Kirchengast & Haslinger, 2009, p. 5). In addition, Mr. Doe suffers from a slipped disk in his back as well as obstructive airway disease, which is a complex group of conditions associated with progressive airway obstruction which is aggravated by periodic asthmatic attacks; this condition has no disease-modifying therapy currently available (Croxton, 2006) and Mr. Doe has been prescribed home-based oxygen supplementation. In addition, Mr. Doe has been diagnosed as being in the first stages of dementia and has exhibited hoarding behaviors that contribute to an unhealthy home environment. Although Mr. Doe retired, it is unclear if he has a pension and there is concern that he is running out of the money needed to allow him to remain in his own home.

As noted above, Mr. Doe has been a widower for 25 years and has two adult children, a 30-year-old son who lives and works abroad and a 35-year-old daughter who lives 4 hours away. Both the adult son and daughter have kept in contact with their father from time to time, but both of them are involved with their own lives and neither of the adult children is aware of the full extent of Mr. Doe's deteriorating health and financial condition. Finally, Mr. Doe's education level is not indicated, and this factor has been related to the level of success of the types of outcomes that can be achieved through social work interventions, and these issues are discussed further below.

Social Work Interventions for Mr. William Doe

Like the majority of other Western societies, Australia is also confronted with increasing pressure to expand the provision of community-based long-term care; the research to date, though, remains inconclusive concerning its cost effectiveness (Calver, Selig & Newton, 2008). One approach that has been shown to be both cost and clinically effective in responding to the needs of the elderly in Australia is the home and community care (HACC) program. In this regard, Cameron, Chanine and Selig advise that, "The home and community care program is an alternative approach to providing ongoing care of semi-dependent people not in need of acute interventions" (p. 440). Likewise, Calver and Holman (2009) report that, "The HACC Program provides support services to assist frail older people and people with disabilities to remain living at home rather than in residential care" (p. 28).

The provision of these services to the elderly in Australia is highly congruent with Moore's (2009) recommendation that social work interventions should be "a model of practice characterised by long-term, non-judgmental, supportive, affirming, relationship-based intervention by connected and respectful workers knowledgeable about their local context" (p. 432). The HACC program is currently funded by substantial contributions from the Commonwealth and state/territory community care budgets and provides services for nearly a half million Australians each year (Calver & Holman, 2009). Moreover, these HACC services have become more personalized in recent years as the result of continuing initiatives by the Western Australia government. In this regard, the Department of Health and Ageing for Western Australia (2013) reports that, "As part of the Living Longer Living Better aged care reforms, the Australian Government is significantly expanding home care to assist people to remain living at home for as long as possible, and to introduce more choice and flexibility for people receiving care at home through Consumer Directed Care (CDC)" (Home Care Packages Program, para. 1).

Although services and protocols differ from jurisdiction to jurisdiction, clients in the HACC program continue to live in their own homes and receive regular visits from workers who provide personal care such as bathing, dressing, feeding, showering or household needs such as laundry, routine cleaning, dusting, and ironing in the majority of HACC programs (Cameron et al., 2008). In addition, some HACC programs provide nursing or domiciliary medical care (Cameron et al., 2008). According to the Department of Health and Ageing for Western Australia, "A Home Care Package is a coordinated package of services tailored to meet the consumer's specific care needs. The package is coordinated by a home care provider, with funding provided by the Australian Government" (para. 3). Currently, home care packages are provided along a continuum of four levels of care as follows:

1. Home Care Level 1 -- to support people with basic care needs;

2. Home Care Level 2 -- to support people with low level care needs (this program is equivalent to the former Community Aged Care Package);

3. Home Care Level 3 -- to support people with intermediate care needs; and,

4. Home Care Level 4 -- to support people with high care needs (Home Care Packages Program, 2013, para. 3).

A full range of health and social services are authorized pursuant to the Home Care Package Program, including care services, support services, clinical services and other services that are designed to help support individuals living at home for as long as possible (Home Care Packages Program, 2013).

A breakdown of Mr. Doe's current issues and how HACC can assist him is provided in Table 1 below.

Table 1

Mr. Doe' Health and Living Issues and Applicability of HACC Program Assistance

Issue/Problem

Description of Problem

Available Assistance

Mild depression

Loneliness and geriatric depression contribute to marked reduction of well being among the elderly. Although major depression is less common among elderly in comparison to middle aged populations, depression is the most prevalent mental function disorder among elderly worldwide. In addition, while depression is not age-related and not a part of normal ageing, especially mild depression has been considered a "normal" effect of aging. Nevertheless, depression in later life remains largely an undetected and untreated condition.

Health services for the treatment of Mr. Doe's mild depression are available through Australia's Community Options Program, Community Aged Care Packages, Aged Care Psychiatry (Psychogeriatric) Services program (Draper, 2004) as well as through Echo Valley hospital's day care program for the elderly and the mental health services team available at Apollos.

Pulmonary rehabilitation (PR) improves exercise capacity and health-related quality of life (HRQoL), and reduces health care utilization (Cecins & Geelhoed, 2008, p. 415). A study by Cecins and Geelhood (2008) found that, "Pulmonary rehabilitation provided in an Australian teaching hospital was associated with a reduction in COPD hospitalisation, and the resultant savings outweighed the costs of providing the program" (p. 416).

Slipped disk

Twice as many men as women suffer from a slipped disk, but the reasons for this difference remain unclear; however, contrary to popular belief, the heavy physical labor performed by Mr. Doe in the past is not associated with a greater risk of a slipped disk (Cavendish, 2005). According to Cavendish, "All slipped disks are in fact ruptured disks. Over 90% of people with a slipped disk recover by resting in bed between 3 days and 3 weeks. If the symptoms persist, patients may have to spend time in the hospital with their legs supported in such a way that pressure on the nerves can be relieved" (p. 1982).